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DOI: 10.1055/s-0038-1637314
EUS GUIDED DILATATION OF STRICTURED BILIO-ENTERIC ANASTOMOSES (BEA)
Publication History
Publication Date:
27 March 2018 (online)
Aims:
Treatment of strictured bilioenteric anastomosis (BEA) is required in 3 – 5% patients. Percutaneous, endoscopic (overtube assisted enteroscopy (OAE) or EUS guided) or surgical approaches are described. Percutaneous & surgical approaches have high morbidity whereas OAE guided endoscopic approach has poor success rates. EUS guided dilatation of HJ strictures has been described earlier. This study reports results of patients treated by EUS guided dilatation of BEA strictures.
Methods:
Retrospective analysis of prospectively maintained database of post-operative BEA strictures treated by EUS guided approach from 2012 – 17. All patients underwent EUS guided dilatation/stent placement via transgastric approach. After EUS guided puncture using 19G needle, cholangiogram obtained to demonstrate stricture. Stricture balloon dilated in one/two sessions over a guidewire. SEMS additionally placed for malignant strictures.
Results:
N = 9; mean age 54.11 years (32 – 73); 7 males. Reason for BEA – cholecystectomy related injury – 5, post Whipple's – 4. Presentation – obstructive jaundice – 9; recurrent cholangitis – 3. Only stricture dilatation – 5, additional SEMS – 4 (confirmed malignancy recurrence). Bougie, balloon or cystotome used for dilatation. All SEMS – single session therapy. Stricture dilatation – 1 session in 1 patient, 2 sessions in 3 & 4 sessions in 1. Trans-hepatic naso-biliary drain between dilatation sessions in 2. Outcomes – technical & clinical success – 100%; bilirubin improved from 5.1 (0.5 – 13.98) (pre) to 3.2 (0.7 – 10.5) (post); Sr. Alkaline phosphatase – 938.2 (251 – 2368) (pre) to 663.7 (122 – 2192) (post). Mean hospital stay 9.5 days (6 – 14). Adverse events – 2 (sepsis – 1; biliary leak with lesser sac collection -1, drained endoscopically); 30-day mortality – 1 (11%) (sepsis). At 1-month follow up, liver parameters improved in all. Subsequent follow up – repeat dilatation required in one after 14 months.
Conclusions:
EUS guided antegrade dilatation/stenting of post-BEA strictures is safe and effective. Technique requires comparison with other modalities.
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